At the start of the social care personalisation movement Community Catalysts CIC recognised the gap between the rhetoric of choice, and the reality of the limited options available for people. In 2007 we were funded by the Department of Health to find ways to support local entrepreneurs and community activists with a passion for supporting people and to help them establish and sustain small community enterprises.
Over an eight year period we have supported the development of approximately 1,000 community enterprises and ventures. Between them these 1,000 ventures care for or support over 10,000 older, disabled or vulnerable people.
What are community entrepreneurs?
Community entrepreneurs run very small (typically less than five workers) local enterprises or ventures that offer a range of social care, housing, leisure and health services or more informal supports. These include helping people to gain a new skill or make friends, lead a healthy life or enjoy a leisure activity. All sorts of people become community entrepreneurs including disabled and older people and family carers. The community enterprises and ventures that they run form a vital part of a diverse local market and provide important services and informal supports that tap into community assets and foster community connections. The enterprises can be run on a spectrum from fully commercial at one end to fully voluntary at the other, with other models such as social enterprise, co-operative, charity and community group in between.
Since 2007, the Government, agencies and individuals have recognised that choice, from a range of diverse options, and control through personal budgets are key to the future development of a person-centred health and social care future.
‘We want services to realise we are a person who has needs, hopes and dreams. Services cannot be one-size-fits-all, we are all different and we should be treated as an individual’ My Life, My Support, My Choice – Think Local Act Personal and National Voices, March 2015
‘England is too diverse for a one-size-fits-all care model to apply everywhere.’ NHS Five Year Forward View
‘Personal health budgets are one option for people living with long-term conditions to have a more flexible and personalised approach to managing their health and their life.’ NHS England
We welcome the consistent and developing focus on collaborative and person-centred care and support, with an ambition to engage communities in promoting health and wellbeing. There are many existing community enterprises and ventures helping local people across the UK, nurturing local connections and creating real choice for people. Ironically these valued community resources are largely invisible to the State, unrecognised and unsupported. With the right help and support these existing community ventures and new community start-ups can flourish. There needs to be support for connections between community ventures, commissioners and strategic thinkers that challenge the status quo and begin to break down barriers to a new future.
Community entrepreneurs in practice
In one rural area we support a village care co-operative run by a small group of sole-traders who work alongside each other to support older people in their community; they offer everything from personal care and a sitting service to handyman and dog walking services. Many members of the co-operative combine this work with other jobs and childcare responsibilities. The local post office is used as an unofficial community hub with one person acting as the informal village care co-ordinator. The reliability, cost-effectiveness and strong outcomes gained by this model are obvious to the village.
In another area we support sole traders, who provide care and support alongside other more specialist offers including hairdressing, gardening, foot care, mindfulness therapy and art. Many of the enterprises and ventures we support encourage people to get active in creative ways and the health outcomes, both physical and mental, are fairly obvious.
DanceSyndrome was founded in 2009 by its Creative Director, Jen Blackwell, who realised that her disability was preventing her from following her desire to be a dance leader. The organisation provides inclusive dance and leadership opportunities for people who believe disability is not a barrier to living life to the full. DanceSyndrome has an equal number of disabled and non-disabled company members and they develop leadership skills in order to deliver high quality inclusive dance workshops for other people with a learning disability and performances for the general public.
Throughout this work we have learnt first-hand about the value of micro-enterprises and ventures; run by entrepreneurs and catalysts rooted in their local communities, able to respond to local people whilst remaining flexible and responsive to changing needs.
Our work has also helped us to recognise and tackle the barriers that community enterprises and ventures face. There can be a lack of information and communication between community ventures and local and health authorities. In many areas, care and support choices are limited to larger scale and more traditional provision by local commissioning and contracting. We know that for a very different health and social care future to emerge there needs to be less reliance on large contracts, and more use of integrated personal health and care budgets, imaginative ‘self-funder’ advice models and social prescribing combined with a real vigour to make these work in practice. Workable pathways also need to emerge that enable health and social care commissioners to procure locally-rooted, community-focused, small scale services and supports.
The newly-emerging health focus on personalised approaches and community options brings real opportunities but also challenges. Community micro-enterprises and ventures can find it difficult to demonstrate the impact of their work and we know that health is much more focused on evidence-based practice than social care. What kind of evidence base will be needed to demonstrate impact and will commissioners value qualitative evidence, for example case studies or testimonials, as well as quantitative data? How do we allay fears and uncertainty when the community healthcare solution chosen by someone is not required to be regulated and doesn’t look like a traditional service familiar to commissioners or professionals? In some areas we are starting to answer some of these questions and sowing the seeds of change.
Whole Body Therapy is a Barking and Dagenham social enterprise founded and run by therapist Sarah Allman who has experience of working with older people including those with dementia in more specialist settings. Through her own personal experience, Sarah discovered the benefits of massage, balance and strength retraining and knows first-hand how a small amount of targeted physical intervention and advice can make a significant difference to someone’s health and wellbeing. Sarah offers a mixture of holistic (relaxation) and deep tissue work which aims to keep people mobile and stable for longer. Sarah’s service also aims to reduce the incidence of falls in older people and aid their rehabilitation after injury. Sarah works with personal budget holders who live in their own home to improve their wellbeing, enhance their quality of life and help maintain their independence and mobility for as long as possible.
Intensive work has been undertaken to identify and tackle any questions and barriers; meeting key professionals face-to-face, sharing information about the service and how it can support people with a personal care or health budget. As a result, social workers and other professionals in the Borough are very positive about the service provided and are making referrals. In response to demand Sarah has recently developed a falls prevention aspect of her service and gained a small amount of money from the Better Care Fund to support this development.
As new policy begins to impact, the integration agenda gains traction and clinical commissioning groups embrace person-centred commissioning, we hope to see the culture and systems change needed to achieve person and community-led care. Disruptive innovation, collaboration between sectors and energetic leadership (with as much focus on outcome as risk) will be needed. Community Catalysts and the community ventures we support are stepping firmly up to the mark and we can’t wait to see who is beside us.
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